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My Phase 2a > Urogenital Diseases > Flashcards

Urogenital Diseases Flashcards

1
Q

What is the epidemiology of urethritis?

A

Most common condition in men at GUM clinics
Non-gonococcal urethritis is more common than gonococcal urethritis
Chlamydia is the most common STI in young people

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2
Q

What are the main causes of urethritis?

A

Gonococcal: Neisseria gonorrhoea
Non-gonococcal: chlamydia trachmatis, mycoplasma genitalium, ureaplasma urealyticum, trichomonas vaginalis
Non-infective: Trauma, urethral stricture, irritation, urinary caliculi

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3
Q

What are the risk factors for urethritis?

A

Sexually active
Unprotective sex
Male to male sex
Male

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4
Q

What is the clinical presentation of urethritis?

A
  • May be asymtpomatic
  • Dysuria +/- discharge
  • Urethral pain
  • Penile discomfort
  • Skin lesions
  • Systemic symptoms
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5
Q

How is urethritis diagnosed?

A

Nucleic acid amplification test (female= self collected vaginal test, male= first void urine)
Microscopy of gram stained smears of genital secretions
Blood cultures
Urine dipstick to exclude UTI

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6
Q

How is chlamydia urethritis treated?

A

Oral ozithromycin stat, or 1 week oral doxycycline

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7
Q

How is gonorrhoea urethritis treated?

A

IM ceftriaxone with oral azithromycin

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8
Q

How is urethritis treated?

A

Treat infection with antibiotics
Test for other STIs
Partner notification

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9
Q

What is urethritis?

A

Urethral inflammation caused by infectious or non-infectious causes. Normally due to an STD

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10
Q

What is the epidemiology of cystitis?

A

Much more common in women
Can occur in children
Most common cause is E coli

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11
Q

What are the risk factors for cystitis?

A

Urinary obstruction resulting in statis
Previous damage to bladder epithelium
Bladder stones
Poor bladder emptying

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12
Q

What is the clinical presentation of cystitis?

A 
Dysuria
Frequency
Urgency
Suprapubic pain
Smelly and cloudy urine
Haematuria 
Abdominal pain
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13
Q

How is cystitis diagnosed?

A

Microscopy and sensitivity of sterile mid-stream urine= positive if there are leucocytes, blood and nitrates

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14
Q

How is cystitis treated?

A

3-5 days of nitrofurantoin or trimethoprim

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15
Q

What is the epidemiology of prostatitis?

A

Common in men of all ages
Most common UTI in men under 50
Usually presents over 35
Associated with LUTs

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16
Q

What is the aetiology of acute prostatitis?

A

Strep. faecalis, E coli, Chlamydia

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17
Q

What is the aetiology of chronic prostatitis?

A

Bacterial ( same as acute) or non-bacterial such as increased prostatic pressure or pelvic floor myalgia

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18
Q

What are the risk factors of prostatitis?

A

STI, UTI, Indwelling catheter, post-biopsy, increasing age

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19
Q

What is the clinical features of acute prostatitis?

A

Systemically unwell, fever, rigors, malaise, pain on ejaculating, dysuria, straining etc.

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20
Q

What are the clinical features of chronic prostatitis?

A

The acute symptoms for more than 3 months, pelvic pain, recurrent UTIs

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21
Q

How is prostatitis diagnosed?

A

DRE: Prostate is tender or hot to touch. Hard from calcification
Urine dipstick: Positive for leucocytes and nitrates
Mid stream urine microscopy and sensitivity
Blood cultures
STI screen
Trans urethral ultrasound scan

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22
Q

How is acute prostatitis treated?

A

IV gentamycin and IV amoxiclav or IV tazocin
2-4 weeks on a quinolone e.g. ciprofloxacin
Second line= Trimethoprim
Truss guided abcess draining

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23
Q

How is chronic prostatitis treated?

A

4-6 week course of quinolone e.g. ciprofolaxacin
+/- alpha blocker= tamsulosin
NSAIDs

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24
Q

What is the epidemiology of benign prostatic hyperplasia?

A
  • More common in over 60s (40%)
  • Unusual before 45
  • Affects Afro-Caribbean population more due to increased testosterone
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25
What are the risk factors for benign prostatic hyperplasia?
- Higher age | - Non-castration
26
Briefly explain the pathology of benign prostatic hyperplasia
Benign nodular or diffuse proliferation of musculofibrous and glandular layers of prostate. Inner (transitional) zone enlarges. As the prostate gets bigger, it may squeeze or partly block the urethra.
27
What is the differential diagnosis of benign prostatic hyperplasia?
Bladder tumour, bladder stones, trauma, prostate cancer, chronic prostatitis, UTI
28
What is the clinical presentation of benign prostatic hyperplasia?
- Lower urinary tract symptoms= nocturia, frequency, urgency, post-micturition dribbling, poor stream, hesitancy, overflow, incontinance, bladder stones, haematuria - Enlarged bladder - Acute urinary retention - Anuria in a small number of cases
29
How is benign prostatic hyperplasia diagnosed?
- DRE: Enlarged but smooth prostate - Transrectal ultrasound: Enlarged prostate - Biopsy and endoscopy - Mid-stream urine sample to check for infection - Serum PSA may be raised - Low urine flow rate - Serum electrolytes and renal ultrasound to exclude renal damage due to obstruction - Frequency vol chart: measure vol voided over a minimum of 3 days
30
How is benign prostatic hyperplasia treated?
- If minimal symptoms, watchful waiting - Lifestyle: Avoid caffeine and alcohol, relax when voiding - Drugs= alpha 1 antagonists and 5 alpha reductase inhibitors - Surgery: Transurethral resection of prostate and transurethral incision of prostate
31
What are some possible complications of benign prostatic hyperplasia ?
Bladder caliculi, haematuria, acute retention, UTI
32
What is the epidemiology of testicular torsion?
Common urological emergency, typically neonates or post-pubertal boys, left side is more common
33
What is the aetiology of testicular torsion?
Underlying congenital malformation- belt clapper deformity, where testis is not completely fixed to scrotum= Free movement
34
What are the risk factors for testicular torsion?
Genetic factors
35
What is the clinical presentation of testicular torsion?
- Sudden onset of pain in one teste should be checked - Pain often comes on during sport or physical activity - Pain in abdomen, nausea and vomitting common - Inflammation of the testes= Tender, hot and swollen - Testes may lie high and transversely
36
What is the differential diagnosis of testicular torsion?
- Epididymo-orchitis - Tumour, trauma and an acute hydrocele - Torsion of testicicular and epididymal appendage
37
How is testicular torsion diagnosed?
Doppler ultrasound may demonstrate lack of blood flow to testes Urinalysis to exclude infection Surgical exploration
38
How is testicular torsion treated?
Surgery- expose and untwist | Orchidectomy (removal of testes) and bilateral fixation
39
What are some complications of testicular torsion?
Infarction of the testicle and atrophy
40
What is the epidemiology of chlamydia?
Most common STI More common in women Most common in 15-25 yr olds
41
What causes chlamydia?
Chlamydia trachomatis (gram -ve bacterium)
42
What are the sites of occurrence of chlamydia/gonorrhoea in adults?
Urethra, endocervical canal, rectum, pharynx, conjunctiva
43
What are the sites of occurrence of chlamydia/gonorrhoea in neonates?
Conjunctiva | Atypical pneumonia also in neonatal chlamydia
44
What is the transmission rate of chlamydia?
``` FTM= 70% MTF= 70% ```
45
What are the clinical features of chlamydia in females?
- Asymptomatic in over 70% | - Non specific symptoms of dysuria, menstrual irregularity and discharge
46
What are the female complications of chlamydia/gonorrhoea infection?
- Pelvic inflammatory disease - Neonatal transmission - Fitz-Hugh-Curtis syndrome
47
What are the male complications of chlamydia infection?
Epidiymo-orchitis and reactive arthritis
48
How is chlamydia treated?
- Partner management - Test for other STIS - Oral Azithromycin stat (convinient 1 dose) or oral doxycycline for 7 days - Pregnant= erythromycin for 14 days or azithromycin stat
49
How is chlamydia diagnosed?
- Nucleic acid amplification tests= High specificity and sensitivity. but -ve test doesn't mean not infected - Females= Self collected vaginal swab, endocervical swab, first void urine - Males= First void urine
50
What is the epidemiology of gonorrhoea?
More common in men
51
What causes gonorrhoea?
Neisseria gonorrhoea= Gram -ve diplococcus
52
What are the clinical features of gonorrhoea in males?
- Dysuria and urethral discharge - Incubation of 2-5 days - Can be asymptomatic
53
What are the clinical features of chlamydia in males?
- Rarely dysuria and discharge - Incubation= 7-21 days - Asymptomatic in 50%
54
What are the rates of transmission of gonorrhoea infection?
- Transmission FTM= 60-80% | - Transmission MTF= 50-90%
55
What are the clinical features of gonorrhoea in females?
- Non specific symptoms of dysuria, menstrual irregularity, discharge - Asymptomatic in 50% - Incubation is up to 10 days
56
How is gonorrhoea diagnosed?
- Near patient test= Microscopy of gram stained smears of genital secretions (gram -ve diplococci) - Male= Sample from urethra - Female= Sample from endocervix, NAAT
57
How is gonorrhoea treated?
- Partner notification - Test for other STIs - Continuous surveillance of antibiotic sensitivity - Single dose treatment of IM ceftriaxone with azithromycin
58
What is the epidemiology of testicular cancer?
- Most common cancer in males aged 15-44 - 10% occur in undescended testes - More than 90% arise from germ cells: seminomas (25-40yrs or 60yrs), or teratomas (infancy) - 4% arise from non germ cells (leydig cells, sertoli cells etc)
59
What are the risk factors for testicular cancer ?
- Undescended testis - Infant hernia - Infertility - Family history
60
What are the differentials for testicular cancer ?
- Testicular torsion - Hydrocele - Lymphoma
61
What are the clinical features of testicular cancer ?
- Painless lump in testicle - Testicular pain and/or abdominal pain - Hydrocele - Cough and dyspnoea= lung metastases - Back pain= Para-aortic lymph node metastases - Abdominal mass
62
How is testicular cancer diagnosed?
- Ultrasound of testicle - Biopsy and histology - Serum tumor markers= AFP or B-hCG - CXR and CT to assess for tumour staging
63
How is testicular cancer treated?
- Radical orchidectomy via inguinal approach - Seminomas with metastases below diaphragm= treated with radiotherapy - More widespread tumours are treated with chemo - Teratomas are treated with chemo - Sperm storage offered
64
What is the epidemiology of bladder cancer?
- Bladder tumours form 50% of all transitional cell carcinomas - More common in males - Incidence peaks in 80s
65
What are the risk factors for bladder cancer?
- Smoking - Occupational exposure to carcinogens= azo dyes, benzidine, occupations including petroleum, cable, rubber and chemical industries - Exposure to drugs e.g. cyclophosphamide, phenacetin - Chronic inflammation of urinary tract - >40yrs - Male - Family history
66
What are the clinical features of bladder cancer?
- Painless haematuria- but may have pain due to clot retention - Any patient over 40 with haematuria should be assumed to have a urothelial tumour until proven otherwise - Recurrent UTIs - Voiding irritability
67
What are the differentials of bladder cancer?
Haemorrhagic cystitis, renal cancer, UTI
68
How is bladder cancer diagnosed?
- Cystoscopy with biopsy= Diagnostic - Urine microscopy/ cytology- cancers may cause sterile pyuria - CT urogram= Provides staging - Urinary tumour markers - MRI/ Lymphangiography may show involved pelvic nodes - CT/MRI of pelvis
69
How is bladder cancer treated?
- Non muscle invasive carcinoma= Surgical resection +/- chemotherapy- CMV Cisplatin, Methotrexate and vinblastine - Localised muscle invasive disease= Radical cystectomy and post op chemo - Radical radiotherapy if not fit for surgery - Metastatic bladder cancer= Palliative chemo and radiotherapy
70
What are the risk factors for prostate cancer?
- Family history - Genetic= HOXB13, BRCA2 - Increasing age - Black men= higher testosterone
71
What is the epidemiology of prostate cancer?
- Most common male malignancy - More common in black men - Incidence increases with age
72
What are the differentials for prostate cancer?
- Benign prostatic hyperplasia - Prostatitis - Bladder cancer
73
What are the clinical features of prostate cancer?
- LUTs if local disease= nocturia, poor stream, hesitancy, terminal dribbling, obstruction - Metastases= Anaemia, weight loss, bone pain
74
How is prostate cancer diagnosed?
- Digital rectal exam= Hard and irregular - Raised PSA - Trans-rectal ultrasound and biopsy= diagnostic- histological diagnosis is essential before treatment - Urine biomarkers e.g. PCA3, or gene fusion protein - Endorectal coil MRI for staging
75
Briefly explain the pathophysiology of prostate cancer
- Most are adenocarcinomas arising in peripheral prostate | - Androgen receptors are responsible for growth
76
How is prostate cancer treated?
- Disease confined to prostate= Radical prostatectomy if <70yrs, hormone therapy, radiotherapy, brachytherapy, active surveillance if >70yrs and low risk - Metastatic disease= Androgen deprivation (orchidectomy, Anti-androgens, androgen receptor blockers)
77
What is the aetiology of epididymo-orchitis?
- Under 35= Chlamydia trachomatis, N gonorrhoea - Over 35= UTI (Klebsiella spp, e coli, enterococci, pseudomonas, staphylococcus) - Mumps - Trauma - Elderly= Catheter related
78
What are the risk factors for Epididymo-orchitis?
- Previous infection - Indwelling catheter - Structural/ functional urinary tract abnormality - Anal intercourse
79
What are the differentials of Epididymo-orchitis?
Testicular torsion- must be ruled out
80
What are the clinical features of Epididymo-orchitis?
- Subacute onset of scrotal pain/ swelling - In STD Epididymo-orchitis= Urethritis, urethral discharge - Mumps= Headache, fever, unilateral, or bilateral parotid swelling - Sweats/ fever - On examination= Tenderness and palpable swelling of epididymis and testicles
81
How is Epididymo-orchitis diagnosed?
- STD screening - Nucleic acid amplification test - Mid stream urine dipstick for UTI - Ultrasound to rule out abscesses - Urethral smear and swab
82
How is Epididymo-orchitis treated?
- Chlamydia= Oral doxycycline for 7 days or stat azithromycin - Gonorrhoea= IM ceftriaxone and stat azithromycin - UTI= Oral ciprofloxacin or oral ofloxacin - Analgesia= NSAIDs - Scrotal support - Abstain from sex - Partner notification
83
What is varicocele?
Abnormal dilation of the testicular veins in the pampiniform venomous plexus, caused by venous reflux
84
What is the epidemiology of varicocele?
- Left side more common - Unusual in boys under 10 - Incidence increases post puberty - Associated with sub fertility
85
What is the aetiology of varicocele?
- More common on left - The angle at which the left testicular vein enters the left renal vein causes increased reflux from compression of the left renal vein
86
What are the clinical features of varicocele?
- Scrotum hangs lower on side of varicocele - Patient may complain of a dull ache or scrotal heaviness - Often visible as distended scrotal blood vessels that feel like a "bag of worms"
87
How is varicocele diagnosed?
- Venography | - Colour doppler ultrasound to see blood flow
88
How is varicocele treated?
Surgery if there's pain, infertility or testicular atrophy
89
What is hydrocele?
Abnormal collection of fluid within tunica vaginalis
90
What is the epidemiology of hydrocele?
- Clinically apparent scrotal hydrocele are evident in 6% of newborns - Most paediatric hydroceles are congenital
91
What is the aetiology of hydrocele?
- Primary= associated with patent processus vaginalis | - Secondary= associated with testis tumour, trauma, infection, TB, testicular torsion, oedema
92
What are the 2 types of hydrocele?
- Overproduction of fluid in the tunica vaginalis (simple) - Processus vaginalis fails to close, allowing peritoneal fluid to communicate freely with scrotal portion (communicating)
93
What are the clinical features of hydrocele?
- Scrotal enlargement with non-tender, smooth, cystic swelling - Pain is not a feature unless hydrocele is infected - Testes are usually palpable but may be difficult in large hydrocele - Lies anterior to and below the tesits
94
How is hydrocele diagnosed?
- Ultrasound | - Serum alpha-fetoprotein and hCG to help exclude malignant teratomas or other germ cell tumours
95
How is hydrocele treated?
- Spontaneously resolves - Many of infancy resolve in 2 years - Therapeutic aspiration or surgical removal
96
What is the epidemiology of epididymal cysts?
- Usually develop around age 40 - Not uncommon - Rare in children
97
What are the clinical features of epididymal cysts?
- Normally present with a lump - Often are multiple and may be bilateral - Small cysts may remain undetected and asymptomatic - Once they get large, they may be painful - Well defined and will transluminate since fluid-filled - Testis is palpable quite separately from the cyst
98
What are the differentials of epididymal cysts?
- Spermatocele - Hydrocele - Varicocele
99
How are epididymal cysts diagnosed?
Scrotal ultrasound
100
How are epididymal cysts treated?
- Usually not necessary | - If painful and symptomatic, surgical excision
101
What are the classic bladder storage symptoms?
- Urgency - Nocturia - Frequency - Overflow incontinence
102
In what diseases are serum phosphate specific antigen raised?
- BPH - Prostate cancer - Perianal trauma and mechanical manipulation of the prostate - BMI <25 - Taller men - Recent ejaculation - Black African - Prostatitis - UTIs
103
What does a maximum flow rate of <10ml per second suggest?
Bladder outflow obstruction due to BPH
104
What are the 5 classic pathogens that cause nearly all UTIs?
KEEPS - Klebsiella spp. - E coli - Enterococci - Proteus spp - Staph spp
105
List the lower urinary tract infections
- Cystitis - Prostatitis - Epididymo-orchitis - Urethritis
106
List an upper urinary tract infection?
Pyelonephritis
107
What causes UTIs to be complicated?
- Abnormal urinary tract structure - Sickle cell - Diabetes - Virulent organisms - Male - Pregnant
108
What are the risk factors for UTI?
- Female - Sex - Pregnancy - Menopause - Decrease in host defence - Obstruction - Catheter
109
What is the epidemiology of UTI?
More common in women, affects a third of women in their lifetime
110
What are the risk factors for ectopic pregnancy?
- Previous ectopic pregnancy - Prior surgery to fallopian tube or pelvis - Certain STDs and PID - Endometriosis
111
How common are ectopic pregnancies?
1 in 90 pregnancies in the UK
112
Where are ectopic pregnancys most commonly found?
The fallopian tube
113
What are the clinical features of ectopic pregnancy?
- Signs of pregnancy including missed period - Abdominal flank/groin pain on one side - Vaginal bleeding or a brown discharge - Pain in the tip of the shoulder - Discomfort when voiding and straining
114
What are the clinical features of a fallopian tube rupture?
A sharp sudden and intense abdominal pain, syncope and dizziness, nausea and vomitting, pallor
115
How are ectopic pregnancies diagnosed?
- +ve Pregnancy test - Transvaginal ultrasound - Blood tests for hCG - Laproscopy
116
How are ectopic pregnancies treated?
- Regular blood tests - Medication- IM methotrexate - Keyhole surgery (laparoscopy) to remove the fertilised egg

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